It could happen before you know it. You are experiencing severe pain from something like shingles or sciatica and taking strong painkillers – whether prescription or over-the-counter (OTC) medication – in order to cope with the pain.
The time comes then when you’re over the bad patch and want to stop taking the medication, but you find yourself experiencing classic “cold turkey” symptoms – anxiety, nausea, headache, flu-like symptoms and palpitations – as you try to stop taking these strong tablets.
It can be confusing, frightening and a bit embarrassing. Never thought you’d be suffering withdrawal symptoms like a drug addict, did you? You needed the painkillers for a while, yes, but now you have another issue to deal with. Knowing what’s happening to you is very important, however – as is telling your doctor, nurse or pharmacist.
Codeine is a relative of heroin
So what causes the addiction? Codeine in these tablets can be the culprit. It is an opium-based drug that is a close relative of heroin, methadone and morphine. It is in over-the-counter medications like Nurofen Plus and Solpadeine and in many prescription painkillers.
In relation to over-the-counter products, because of the risk of dependency, legislation came in in 2010 that meant customers can be quizzed by pharmacists about why they want to buy such medication. That was on foot of statistics that showed Irish people spending €21 million on Solpadeine in 2009, for example.
Due to the 2010 legislation, we are now all asked why we need such OTC drugs when we try to buy them and if the pharmacist suspects that a customer is abusing or addicted to them they may be refused or referred to their GP.
Addiction greater in women
In relation to addiction, the Rutland Treatment Centre in Dublin says that addiction to pain medication is greater in women. A study in St Patrick’s Hospital, Dublin, showed that, of those admitted for OTC opiate abuse treatment, the female:male ratio was nearly 2:1, with an average age of 49.2 years. In the case of Nurofen Plus, mostly 20-30 year olds were affected.
Some referrals to the Rutland Centre came from pain management clinics, they say, where people being treated for conditions like fibromyalgia or neuropathic pain had developed addictions to their pain medication.
Very strong prescription painkillers are often prescribed for severe back pain, nerve pain related to shingles and diabetic neuropathy (nerve damage due to diabetes).
Three days to addiction
Most people don’t know that addiction (dependence) on painkillers can happen after three days’ usage. Caitriona O’Riordain is a community pharmacist based in Inishkeen in west Cork and stresses the importance of pharmacists and doctors making patients aware that dependence can occur very rapidly.
“We’d hope the doctor would have discussed this with the patient and that the pharmacist would too, as dependence can occur if you use them for longer than three days.”
But what does she do if she suspects a customer is dependent on this medication? If it’s over-the-counter medication, she would bring up the causes. “Some people come in to buy a lot of headache medication, but pharmacists would point out that if the pain is that bad they should be seeing their GP anyway to get to the bottom of it,” Caitriona explains.
What’s the cause of the pain? That has to be looked into also
“People may think they are unfairly being asked too many questions, but it’s all evidence based. Those regulations were brought in because opiates have a far higher risk of dependence.
“Generally speaking, you can ascertain if someone is genuine or not and if they are in pain or not. They may genuinely need it, but what’s the cause of the pain? That has to be looked into also.”
Paracetamol and ibuprofen tablets are available more easily, but they are stored behind the counter in the pharmacy now also, she says. “That’s so that there will be interaction between the customer and the pharmacist or counter staff before they buy them,” she says.
Headache medication can cause headache
Surprise! If you take a lot of headache medication, it can cause headaches. “You can experience headaches when you try to stop taking headache medication if you’ve been taking them very regularly,” Caitriona says.
“Many people don’t know or believe this but it’s true: it’s your body reacting to the absence of something.”
What advice does a pharmacist give?
When a customer comes in looking for a particular painkiller, what does the pharmacist do? “If we suspected there was a problem, we’d try to encourage him or her to buy something further down the (strength) ladder, like paracetamol. It can be a difficult situation for the pharmacist sometimes, yes,” she agrees.
Doctors and pharmacists do alert each other to individuals’ perceived dependence on painkillers too. “If we professionals become aware that a person in an area is chronically misusing the medicine, there is a way of communicating that to pharmacists on a wider scale,” Caitriona says.
“I have come across situations also where a GP in a town will ring all the pharmacists too and say that such and such a person should not be sold any painkilling medication and that what they need is support, rather than medication. It’s not a Big Brother situation, though. It’s about supporting the person.”
Having a good relationship with your pharmacist is important, she says. “Pharmacists are very approachable. People are usually open to dialogue if you approach the subject gently. Sometimes it’s a relief in itself for the person to get what’s happening out in the open. Apart from asking them to talk to their GP, we’d be so aware of support services in our areas that we can direct people to.”
Pharmacists work as a team with doctors, she adds. “Sometimes people in this situation will ask their GP to contact pharmacists in the area to tell them not to sell them painkillers, as they feel they can’t help themselves.”
But what’s to stop a person buying OTC tablets in a second pharmacy after being refused in the first? “You can’t fully stop people buying painkillers in one pharmacy then buying more in another pharmacy, but experience and professional judgement has a lot to do with it. Action usually comes down to professional judgment and experience,” she says.
“In some cases, you’d sell them a smaller packet and make sure they don’t get it again without seeing their doctor, but you generally know. Generally speaking, if I think that someone has an issue with them, I try and speak with them myself.
“ I usually find that they really open up and say yes they have developed dependence and they know that. Most people are looking for a way out of the vicious circle of withdrawal symptoms like irritability and anxiety,” she explains.
But pharmacies are businesses – isn’t there commercial pressure to sell such tablets? “At the end of the day, you’re a professional first and a business wouldn’t sink or swim on a box of Nurofen Plus. But if professionalism doesn’t come first you’re in the wrong job,” she says.
Referral to pain management specialist
If patients seek more prescription medication but their GP is disinclined to write the prescription, their doctors may refer them to a pain management specialist.
“If it’s a case that the GP has reason to think the person has no pain and has become dependent, I’d be surprised if the GP didn’t refer them for therapy service or that the GP wasn’t working with them to wean them off the medication,” says Caitriona. CL
Addiction support and advice
Private areas in pharmacies
There are now private areas in pharmacies where you can chat with your pharmacist if you need to but are these facilities being used? “Initially there was a little bit of unease about it, with people thinking ‘Why am I being dragged in there?’ but people have come to realise now that it’s a positive,” Caitriona says. “We try to use the spaces as much as possible so that people are comfortable with them, doing blood pressure checks and diabetes screening and so on. It’s about building up trust with patients.”
How pharmacists know you may be addicted or dependent
You ask for particular medications regularly.You ask for a specific brand like Nurofen Plus or Benylin Original.You ask for bigger packs.You get irate when refused them.You have prepared answers to the pharmacist’s questions.You don’t want any other type of medication.How you know you are becoming or are dependent on painkillers?
You suffer withdrawal symptoms if you try to reduce the number you are taking or if you stop suddenly.You think about your medication a lot.You feel panicky if you don’t have any.You take different amounts than your doctor prescribed.You’re “doctor shopping”.You get painkillers from other sources eg relatives, the internet.You’ve been taking them for a long time.You get angry if someone talks to you about it.You may be moody and not sleeping very well.Where can I get help?
Honesty is key. If you suspect you’ve become dependent on painkillers talk to someone straight away – your GP, nurse or pharmacist.
There are also specialist centres that can advise you – like Aiseiri or the Rutland Centre in Dublin – if the situation is serious.
Long-term damage of painkillers
It could happen before you know it. You are experiencing severe pain from something like shingles or sciatica and taking strong painkillers – whether prescription or over-the-counter (OTC) medication – in order to cope with the pain.
The time comes then when you’re over the bad patch and want to stop taking the medication, but you find yourself experiencing classic “cold turkey” symptoms – anxiety, nausea, headache, flu-like symptoms and palpitations – as you try to stop taking these strong tablets.
It can be confusing, frightening and a bit embarrassing. Never thought you’d be suffering withdrawal symptoms like a drug addict, did you? You needed the painkillers for a while, yes, but now you have another issue to deal with. Knowing what’s happening to you is very important, however – as is telling your doctor, nurse or pharmacist.
Codeine is a relative of heroin
So what causes the addiction? Codeine in these tablets can be the culprit. It is an opium-based drug that is a close relative of heroin, methadone and morphine. It is in over-the-counter medications like Nurofen Plus and Solpadeine and in many prescription painkillers.
In relation to over-the-counter products, because of the risk of dependency, legislation came in in 2010 that meant customers can be quizzed by pharmacists about why they want to buy such medication. That was on foot of statistics that showed Irish people spending €21 million on Solpadeine in 2009, for example.
Due to the 2010 legislation, we are now all asked why we need such OTC drugs when we try to buy them and if the pharmacist suspects that a customer is abusing or addicted to them they may be refused or referred to their GP.
Addiction greater in women
In relation to addiction, the Rutland Treatment Centre in Dublin says that addiction to pain medication is greater in women. A study in St Patrick’s Hospital, Dublin, showed that, of those admitted for OTC opiate abuse treatment, the female:male ratio was nearly 2:1, with an average age of 49.2 years. In the case of Nurofen Plus, mostly 20-30 year olds were affected.
Some referrals to the Rutland Centre came from pain management clinics, they say, where people being treated for conditions like fibromyalgia or neuropathic pain had developed addictions to their pain medication.
Very strong prescription painkillers are often prescribed for severe back pain, nerve pain related to shingles and diabetic neuropathy (nerve damage due to diabetes).
Three days to addiction
Most people don’t know that addiction (dependence) on painkillers can happen after three days’ usage. Caitriona O’Riordain is a community pharmacist based in Inishkeen in west Cork and stresses the importance of pharmacists and doctors making patients aware that dependence can occur very rapidly.
“We’d hope the doctor would have discussed this with the patient and that the pharmacist would too, as dependence can occur if you use them for longer than three days.”
But what does she do if she suspects a customer is dependent on this medication? If it’s over-the-counter medication, she would bring up the causes. “Some people come in to buy a lot of headache medication, but pharmacists would point out that if the pain is that bad they should be seeing their GP anyway to get to the bottom of it,” Caitriona explains.
What’s the cause of the pain? That has to be looked into also
“People may think they are unfairly being asked too many questions, but it’s all evidence based. Those regulations were brought in because opiates have a far higher risk of dependence.
“Generally speaking, you can ascertain if someone is genuine or not and if they are in pain or not. They may genuinely need it, but what’s the cause of the pain? That has to be looked into also.”
Paracetamol and ibuprofen tablets are available more easily, but they are stored behind the counter in the pharmacy now also, she says. “That’s so that there will be interaction between the customer and the pharmacist or counter staff before they buy them,” she says.
Headache medication can cause headache
Surprise! If you take a lot of headache medication, it can cause headaches. “You can experience headaches when you try to stop taking headache medication if you’ve been taking them very regularly,” Caitriona says.
“Many people don’t know or believe this but it’s true: it’s your body reacting to the absence of something.”
What advice does a pharmacist give?
When a customer comes in looking for a particular painkiller, what does the pharmacist do? “If we suspected there was a problem, we’d try to encourage him or her to buy something further down the (strength) ladder, like paracetamol. It can be a difficult situation for the pharmacist sometimes, yes,” she agrees.
Doctors and pharmacists do alert each other to individuals’ perceived dependence on painkillers too. “If we professionals become aware that a person in an area is chronically misusing the medicine, there is a way of communicating that to pharmacists on a wider scale,” Caitriona says.
“I have come across situations also where a GP in a town will ring all the pharmacists too and say that such and such a person should not be sold any painkilling medication and that what they need is support, rather than medication. It’s not a Big Brother situation, though. It’s about supporting the person.”
Having a good relationship with your pharmacist is important, she says. “Pharmacists are very approachable. People are usually open to dialogue if you approach the subject gently. Sometimes it’s a relief in itself for the person to get what’s happening out in the open. Apart from asking them to talk to their GP, we’d be so aware of support services in our areas that we can direct people to.”
Pharmacists work as a team with doctors, she adds. “Sometimes people in this situation will ask their GP to contact pharmacists in the area to tell them not to sell them painkillers, as they feel they can’t help themselves.”
But what’s to stop a person buying OTC tablets in a second pharmacy after being refused in the first? “You can’t fully stop people buying painkillers in one pharmacy then buying more in another pharmacy, but experience and professional judgement has a lot to do with it. Action usually comes down to professional judgment and experience,” she says.
“In some cases, you’d sell them a smaller packet and make sure they don’t get it again without seeing their doctor, but you generally know. Generally speaking, if I think that someone has an issue with them, I try and speak with them myself.
“ I usually find that they really open up and say yes they have developed dependence and they know that. Most people are looking for a way out of the vicious circle of withdrawal symptoms like irritability and anxiety,” she explains.
But pharmacies are businesses – isn’t there commercial pressure to sell such tablets? “At the end of the day, you’re a professional first and a business wouldn’t sink or swim on a box of Nurofen Plus. But if professionalism doesn’t come first you’re in the wrong job,” she says.
Referral to pain management specialist
If patients seek more prescription medication but their GP is disinclined to write the prescription, their doctors may refer them to a pain management specialist.
“If it’s a case that the GP has reason to think the person has no pain and has become dependent, I’d be surprised if the GP didn’t refer them for therapy service or that the GP wasn’t working with them to wean them off the medication,” says Caitriona. CL
Addiction support and advice
Private areas in pharmacies
There are now private areas in pharmacies where you can chat with your pharmacist if you need to but are these facilities being used? “Initially there was a little bit of unease about it, with people thinking ‘Why am I being dragged in there?’ but people have come to realise now that it’s a positive,” Caitriona says. “We try to use the spaces as much as possible so that people are comfortable with them, doing blood pressure checks and diabetes screening and so on. It’s about building up trust with patients.”
How pharmacists know you may be addicted or dependent
You ask for particular medications regularly.You ask for a specific brand like Nurofen Plus or Benylin Original.You ask for bigger packs.You get irate when refused them.You have prepared answers to the pharmacist’s questions.You don’t want any other type of medication.How you know you are becoming or are dependent on painkillers?
You suffer withdrawal symptoms if you try to reduce the number you are taking or if you stop suddenly.You think about your medication a lot.You feel panicky if you don’t have any.You take different amounts than your doctor prescribed.You’re “doctor shopping”.You get painkillers from other sources eg relatives, the internet.You’ve been taking them for a long time.You get angry if someone talks to you about it.You may be moody and not sleeping very well.Where can I get help?
Honesty is key. If you suspect you’ve become dependent on painkillers talk to someone straight away – your GP, nurse or pharmacist.
There are also specialist centres that can advise you – like Aiseiri or the Rutland Centre in Dublin – if the situation is serious.
Long-term damage of painkillers
Anxiety.Distress of being dependent/
addicted.Expense of purchasing
medication.Internal bleeding.Memory loss.Digestive system
damage.Liver damage.Kidney
damage.Severe headaches. 
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